Will Home Care Unionize?

I suppose that my education qualifies me as an economist, but a detailed analysis of the effects of unionization on home care, home health and related services such as HME, Infusion, and home Therapy will not be forthcoming here. What I would simply like to do is to make you aware of this if you are not already: There are very real efforts out there to unionize healthcare services of all kinds. Home health care and home care is no exception.

The Seattle Times reported last week on Initiative 1163, which would increase training and continuing education requirements for targeted healthcare workers, and is being led by the Service Employees International Union (SEIU) local 775. Initiative 1163 is largely described as an initiative to improve the quality and welfare of long term care employees, but often overlooked is the fact that it includes those who work in private homes, boarding homes and assisted living facilities.

Regardless of whether you think unions are valuable, obsolete, or inherently good or evil is irrelevant. If you don’t think that unions are paying attention to healthcare, think again. Consider why unions are targeting healthcare and home care:

Union Membership Fell to a 70 Year Low last Year, according to the Bureau of Labor Statistics. Just 11.9% of Americans are now in unions, and now for the first time in over a century, more than half of them work for the government. More than 20% of the workforce was in unions just 30 years ago. See related article in The New York Times. Naturally, the decline in traditionally unionized sectors such as manufacturing and construction contribute significantly to these declines.

Healthcare remains the largest and fastest growing employment sector, with a majority of that growth happening in ambulatory health care services. Non-medical home care is not even imputed in this statistic, grossly understating the real employment number. Data: Bureau of Labor Statistics report Oct 7, 2011.

The one bright spot for unions seems to be healthcare, where membership is actually growing. Fewer Healthcare and home care workers in particular are unionized compared with non-healthcare industries. With many millions of workers in the fastest growing employment sector not unionized, the sector represents a huge growth opportunity for unions. Fierce Healthcare

Segments targeted by Initiative 1163 are among the lowest skilled and lowest paid workers in the healthcare continuum, making them excellent candidates for union membership. As is the case in Washington, unions can point to areas where legislation and ensuing union membership has increased pay dramatically for these workers. In Washington State, after initiative 775, home care wages increased 18%+ and union membership soared from 1500 to more than 40,000 workers, according to the Seattle Times.

Still not convinced that unions are serious about home care? The local 775 of the SEIU spent $2.6 million on Initiative 1163 over the last four years, including more than $1 million on signature gathering alone. This was a business decision to invest in employment segment that will likely provide significant returns for them in growing membership.

Note that I am not taking sides—I’ve simply presented facts to prove that unions are likely to become a new and increasing factor in the areas of healthcare and home care that we serve. Accountable Care Organizations (ACOs) will increasingly have to consider this in developing their Care Coordination models, as well.

The fact is that the business that Ankota’s customers are in is already under significant duress, with threats from payment reform, availability of labor, rising costs, and more. Unions are entering the mix at an increasing rate and must be accounted for. Like any disruption, this will present business risks and opportunities.

What do you think? Would unionization ultimately help or hurt your business? Would it help or hurt overall employement in our industry?